Insurance Questions

Frequently Asked Questions for Our Services 

Will insurance cover my neuropsychological testing?  We are contracted with many insurance companies and also work regularly with many others as out-of-network providers to ensure you can get the most out of your insurance benefits with the least out-of-pocket expense.  However, even if we are contracted by your insurance company, each insurance contract (even by same insurance provider) differs in mental health coverage.  The first thing to find out is what mental health benefits your insurance policy offers. We will call your insurance carrier to determine (a)  whether your policy includes coverage for mental health services, (b) types of services that are covered and the amount paid for these services, and (c ) any steps we must take to have treatment covered. Further, many Insurance companies have medical necessity requiring that services be (a) medically necessary and (b) referred by a primary treating provider (primary care, neurology, etc).  Our pre-verification staff works with your insurance company to determine this information and calculate estimated out-of-pocket expenses.  We discuss all this information in detail with you beforehand so you can be fully informed of your costs before you schedule.  By the time you arrive at our office for your first appointment, you will know exactly what to expect.

Will insurance cover my child’s (or my) psychoeducational/school testing?  Unfortunately, insurance companies do not consider some psychoeducational testing, such as  Leaning Disabilities as “medically necessary” and therefore they will not cover the cost.  However, some conditions that affect learning, such as Attention Deficit Hyperactivity Disorder (ADHD), Pervasive Developmental Disorder (PDD), or Autism Spectrum Disorder might be eligible for “medically necessary” coverage.  If this is a question your pediatrician, family physician, or neurologist has, he/she should include to in referral to us.  In cases where only knowledge about a Specific Learning Disorder (SLD) or Intellectual Disability is sought, it is probable that insurance companies may nit deem this a medically necessary question.  While insurance companies may not consider some services “necessary”, we understand how vital this evaluation can be for success in school, and therefore, we offer a variety of self pay options, prompt pay discounts, and even offer promotional discounts periodically to help families get the services they need.  We discuss all this information in detail with you beforehand so you can be fully informed of your costs before you schedule.  By the time you arrive at our office for your first appointment, you will know exactly what to expect.

Will insurance cover my child’s (or my) neurofeedback? Unfortunately, insurance companies do not cover neurofeedback.  While insurance companies may not consider this service “necessary”, taking an active step to improve you or your child’s daily functioning and quality of life is very important.  We offer a variety of self pay options, bundle purchasing discounts, and even offer promotional discounts periodically to help families get the services they need.  We discuss all this information in detail with you beforehand so you can be fully informed of your costs before you schedule.  By the time you arrive at our office for your first appointment, you will know exactly what to expect.

 Will insurance cover my child’s (or my) ADHD testing?  Some insurance companies do cover the neuropsychological testing for ADHD and some do not consider it “medically necessary” and therefore they will not cover the cost.  Our staff is well-trained to work with your insurance company to determine all options to get the testing covered if at all possible.  While some insurance companies may not consider this service “medically necessary”, we understand how vital this evaluation can be for success in daily living and school/work, and therefore, we offer a variety of self pay options, prompt pay discounts, and even offer promotional discounts periodically to help families get the services they need.  We discuss all this information in detail with you beforehand so you can be fully informed of your costs before you schedule.  By the time you arrive at our office for your first appointment, you will know exactly what to expect.

Will Medicare cover differential diagnosis for dementia?  Yes.  With a referral from a medical doctor (e.g. primary care or neurologist), Medicare considers neuropsychological assessment a “medically necessary” evaluation, covered at 80%.  If you have secondary insurance, it typically picks up the remaining 20%, depending on your policy.  We pre-verify your Medicare benefits, including deductible and copay responsibilities before your arrival.  You will fully informed of your cost for service before you schedule. By the time you arrive at our office for your first appointment, you will know exactly what to expect.

Do I need a referral from my primary care physician to a mental health professional? Many insurance companies require referrals from a primary care physician to visit any specialist, including mental health professionals. We can help contact your primary care physician to avoid your insurance company from denying your claims. If you think you require a referral, we must always get it in advance of seeing you. We will ask your help in getting a release of information to your primary care physician for a referral.

 Do I need any pre-approval from the insurance company before I see a mental health professional? Pre-approval or pre-authorization­ requires that your insurance company agrees to make the payment. We will call your insurance company to see if you need pre-approval and to determine your financial responsibility for this visit (i.e., deductibles, copay).   You will fully informed of your cost for service before you schedule. By the time you arrive at our office for your first appointment, you will know exactly what to expect. We are required to collect all monies owed at time of visit.  We cannot legally waive any deductibles or copays which your have contractually agreed to pay as part of your insurance carrier’s policy.

 

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